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State-Specific Prevalence of Obesity Among Adults --- United States, 2007

Obesity is associated with reduced quality of life, development of serious chronic conditions such as heart disease
and diabetes, increased medical care costs, and premature death
(1,2). A Healthy People 2010 objective is to reduce to 15%
the proportion of adults who are obese (3). In 2005, no state met this target, and (based on self-reported height and
weight) 23.9% of adults in the United States were obese
(4). To update 2005 estimates of the prevalence of obesity in adults,
CDC analyzed data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey. The results of that analysis
indicated that 25.6% of respondents overall in 2007 were obese; the prevalence of obesity among adults remained above 15% in
all states and was above 30% in Alabama, Mississippi, and Tennessee. Enhanced collaborative efforts among national, state,
and community groups are needed to establish, evaluate, and sustain effective programs and policies to reduce the prevalence
of obesity in the United States.

BRFSS is an ongoing, state-based, random-digit--dialed telephone survey of the noninstitutionalized U.S.
civilian population aged >18 years. Survey data are used to monitor progress in achieving health objectives at the state level and
in selected metropolitan statistical
areas.* Data are weighted to the
respondents' probabilities of being selected and to the
age-, race-, and sex-specific populations from each state's annually adjusted census. In the 2007 BRFSS survey, Council of
American Survey and Research Organizations (CASRO) response
rates among states ranged from 26.9% to 65.4% (median:
50.6%), and cooperation rates§ ranged from 49.6% to 84.6% (median: 72.1%).

Body mass index (BMI) (weight [kg] / height
[m]2) was calculated from self-reported weight and height at the time of
the survey. Obesity was defined as a BMI
>30.0. (1). To maintain consistency with previous analyses
(4,5), respondents with self-reported weight
>500 pounds or height >7 feet were excluded.

In the 2007 BRFSS survey, 25.6% of respondents overall were obese. Obesity prevalence was 26.4% for men and 24.8%
for women (Table). By age group, obesity prevalence ranged from 19.1% for men and women aged 18--29 years to 31.7%
and 30.2%, respectively, for men and women aged 50--59 years. By race/ethnicity and sex, obesity prevalence was highest for
non-Hispanic black women (39.0%) followed by non-Hispanic black men (32.1%).

By education level, for men, obesity prevalence was lowest among college graduates (22.1%) and highest among those
with some college (29.5%) and a high school diploma (29.1%). For women, obesity prevalence was lowest among college
graduates (17.9%) and highest among those with less than a high school diploma (32.6%).

By region, the prevalence of obesity was higher in the South (27.3%) and Midwest (26.5%) and lower in the
Northeast (24.4%) and West (23.1%) (Table). State-specific obesity prevalence ranged from 18.7% to 32.0% and was <20% in only
one state: Colorado (18.7%) (Figure). Obesity prevalence
was >30% in three states: Alabama (30.3%), Mississippi
(32.0%), and Tennessee (30.1%). No state met the
Healthy People 2010 target of 15%, and 30 states had
obesity prevalence >25%.

Editorial Note:

The findings in this report indicate that, in 2007, none of the 50 states nor the District of Columbia
had reached the Healthy People 2010 target for obesity prevalence among adults aged
>18 years. The 25.6% prevalence of
obesity among respondents overall in the 2007 BRFSS survey represents an increase of 1.7 percentage points from the
23.9% prevalence in 2005. In 2000, the prevalence was 19.8%, and in 1995 the prevalence was 15.3%
(4). State and national data indicating that obesity prevalence has continued to increase during much of the past two decades
(4--7) underscore the public health challenge presented by obesity. Of further concern are the disparities in prevalence of obesity, particularly among
racial/ethnic populations and by education level. These disparities might reflect differences in knowledge and behavior related to
diet and physical activity. They also might reflect
differences in environmental supports for these behaviors, such as access to
places for physical activity (e.g., local parks or recreation facilities) or access to healthier food
options (e.g., selection at local groceries).

To reach the Healthy People 2010
target,increased national attention to actions that promote healthy eating and
physical activity is essential. In the Surgeon General's 2001
Call to Action to Prevent and Decrease Overweight and Obesity
(2), 15 activities were identified as national priorities for immediate action; many focus on increased access to healthy food
choices and safe physical activity in settings such as worksites, communities, and schools. The report also called for
collaboration
across multiple sectors (i.e., education, government, and business) and levels (i.e., individual, family, community, state,
and national) to address the problem of obesity.

CDC conducts obesity prevention programs and activities with a wide range of partners, including state and local
health and education departments and communities across the
country.¶ For example, as part of CDC's Nutrition and
Physical Activity Program to Prevent Obesity and Other Chronic Diseases, the state of Washington implemented a
community intervention that promotes environmental and policy changes to help encourage healthful nutrition and physical
activity. Changes included widening sidewalks, connecting systems of paths for pedestrians and bicyclists, and creating
community gardens. Examples of other approaches were highlighted in a meeting of representatives from 25 community programs,
held July 10--11, 2008, at CDC. Examples included increasing access to healthier foods through farmer's markets,
community gardens, and local groceries; altering roads and sidewalks to make them safer and more accessible to pedestrians and
bicyclists; creating or enhancing access to physical activity through parks, trails, or community fitness trails; and creating social
support for physical activity through walking clubs.

CDC also works with employers and worksite health
experts to translate evidence-based recommendations from the
Task Force on Community Preventive Services
(8) on worksite interventions for preventing obesity into business practices.
This collaboration will produce a return-on-investment calculator to assist businesses in making the case for initiation
and maintenance of wellness programs, especially those that promote weight management. In addition, an interactive website
will provide guidance for the creation, expansion, or customization of worksite obesity programs.

Efforts to help address obesity in the health-care setting also are occuring. For example, the National Committee for
Quality Assurance recently approved inclusion of BMI assessment for adults as a Health Plan Employer Data and Information
Set (HEDIS) measure. This assessment should help prompt health-care providers to provide appropriate counseling
regarding diet and physical activity to their patients.

The findings in this report are subject to at least two limitations. First, BRFSS data depend on self-reported height
and weight, and obesity prevalence is likely underestimated
because survey participants tend to overstate their height
and understate their weight, or both
(9).Second, persons without landline telephones are excluded from BRFSS, which
might affect obesity estimates. Persons without landline telephones, including those who use only cellular telephones, might
be younger or of lower socioeconomic status
(10).

Expansion of multidisciplinary, cross-sector collaborations and partnerships that seek to improve nutrition and physical
activity in settings such as schools, workplaces, and communities will be an important strategy to reduce obesity prevalence in the
United States. Priority should be given to interventions that move beyond increasing individual awareness and provide the
environmental and policy changes that support behavior change, particularly among those with the greatest need.

Acknowledgment

The findings in this report are based, in part, on data provided by BRFSS state coordinators.

References

National Heart, Lung, and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in
adults: the evidence report. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and
Blood Institute; 1998. Available at
http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.htm.

US Department of Health and Human Services. The Surgeon General's call to action to prevent and decrease obesity. Rockville, MD:
US Department of Health and Human Services, US Public Health
Service, Office of the Surgeon General; 2001. Available at
http://www.surgeongeneral.gov/topics/obesity.

Blumberg SJ, Luke JV. Wireless substitution: early release of estimates based on data from the National Health Interview Survey,
July--December 2007. Rockville, MD: US Department of Health and
Human Services, CDC, National Center for Health Statistics; 2008. Available
at http://www.cdc.gov/nchs/data/nhis/earlyrelease/wireless200805.htm.

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